Provider Demographics
NPI:1114249364
Name:CORDILLERAS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CORDILLERAS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:650-367-1890
Mailing Address - Street 1:200 EDMONDS RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3813
Mailing Address - Country:US
Mailing Address - Phone:650-367-1890
Mailing Address - Fax:
Practice Address - Street 1:200 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3813
Practice Address - Country:US
Practice Address - Phone:650-367-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063509125323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility